| NPI | 1376791137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 07765R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39055) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2021-10-19 |