| NPI | 1568831121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 293174) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10637) |
| 225100000X Physical Therapist (Licence: CA PT293174) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2021-09-17 |