| NPI | 1689991986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 36691) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2022-06-15 |