| NPI | 1669818993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012033505) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2023-07-06 |