| NPI | 1669018693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT295890) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2020-09-02 |