| NPI | 1568414233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 00798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297084) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-03-27 |