| NPI | 1205170099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293327) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010845) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2018-06-01 |