| NPI | 1326582503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18271) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292563) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2018-12-18 |