| NPI | 1700847662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4549) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT29781) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2022-06-12 |