| NPI | 1154932358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT298841) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-10-20 |