| NPI | 1619314424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40938) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011018) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2021-11-29 |