| NPI | 1568822823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41195) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9513) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-12-08 |