| NPI | 1649752700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT302240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018799) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2024-12-24 |