| NPI | 1316375132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT295677) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60415927) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2021-05-27 |