| NPI | 1700335510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 34013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292008) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2018-10-01 |