| NPI | 1144551342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 4161674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36325) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2024-09-30 |