| NPI | 1174191225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 013213) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2023-08-09 |