| NPI | 1497236384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT295173) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013600) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2021-09-30 |