| NPI | 1407516099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 301739) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4301) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2022-04-07 |