| NPI | 1043524192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36855) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27758) |
| Enumeration Date | 2010-07-31 |
| Last Update Date | 2020-05-07 |