| NPI | 1245762293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 43156) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2018-06-25 |