| NPI | 1356875793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 4375) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2019-06-24 |