| NPI | 1104381888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019033518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296214) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2019-09-17 |