| NPI | 1639647035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT027264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027264) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-02-23 |