| NPI | 1619242567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38742) |
| Enumeration Date | 2012-03-11 |
| Last Update Date | 2021-01-14 |