| NPI | 1700909421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32560) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-07-26 |