| NPI | 1538640990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6345) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2018-08-23 |