| NPI | 1497131445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.010583) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2017-02-19 |