| NPI | 1568021418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9739) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296700) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-06-26 |