| NPI | 1720509177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296470) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012614) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2023-02-23 |