| NPI | 1386260776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 298023) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |