| NPI | 1194227363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305059) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 49204) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2023-11-07 |