| NPI | 1386023109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42498) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-06-24 |