| NPI | 1659823219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292233) |
| 225100000X Physical Therapist (Licence: AR 4228) | |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2018-12-05 |