| NPI | 1578664991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3956) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-02-21 |