| NPI | 1043584576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 33052) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2022-05-17 |