| NPI | 1245746510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT294186) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2020-03-24 |