| NPI | 1699294660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13965-24) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2019-01-22 |