| NPI | 1669242830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 305126) |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |