| NPI | 1467066654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 016008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 298170) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-05-15 |