| NPI | 1073969804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012312) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2024-05-08 |