| NPI | 1730847625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 0000013165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291918) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |