| NPI | 1265982045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 31695) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2019-11-06 |