| NPI | 1518259118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT CP014678T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37607) |
| Enumeration Date | 2011-05-14 |
| Last Update Date | 2022-12-06 |