| NPI | 1083134225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5274) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2019-09-18 |