| NPI | 1457746067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-4887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42444) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2023-02-27 |