| NPI | 1548780752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295051) |
| 225100000X Physical Therapist (Licence: TN 11306) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-06-21 |