| NPI | 1164918603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019011728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT294996) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2022-07-03 |