| NPI | 1336619766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 5022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT295728) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2023-03-20 |