| NPI | 1649620857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293713) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12256) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2021-07-05 |