| NPI | 1093202525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09962R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT297854) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2021-01-26 |