| NPI | 1518424449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT299521) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27345) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2022-02-26 |