| NPI | 1538536859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21978) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2021-06-10 |