| NPI | 1578939831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296836) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11774) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2020-12-20 |