| NPI | 1518356880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT291443) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3071) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2023-08-16 |