| NPI | 1073350435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA CP032087T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4668) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-07-12 |