| NPI | 1225583487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 5537) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2020-03-05 |