| NPI | 1437550969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37496) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2021-01-20 |