| NPI | 1265955025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13842-24) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-07-22 |