| NPI | 1003390329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295124) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2024-08-06 |