| NPI | 1447769997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8708) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2021-01-20 |