| NPI | 1619023553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2264) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2018-03-21 |