| NPI | 1386032365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42525) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25281) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2021-04-29 |