| NPI | 1538648357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT298609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11298) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2022-09-21 |