| NPI | 1508214743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293214) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22984) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-01-05 |