| NPI | 1518563519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 293922) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |