| NPI | 1205202652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30614) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2019-02-06 |