| NPI | 1578647996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT29751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4406) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-09-21 |