| NPI | 1013013861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14574) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CA 23775) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-10-13 |