| NPI | 1235443177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT304975) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8572) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2024-10-29 |