| NPI | 1396113569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15747) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42737) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2024-06-25 |