| NPI | 1720465883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013208) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-04-28 |