| NPI | 1114324233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41945) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2018-04-17 |