| NPI | 1730530353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210342) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2020-01-08 |