| NPI | 1679177307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298723) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT298723) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2021-05-13 |