| NPI | 1144993353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64051) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-07-26 |