| NPI | 1780185892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3667) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-03-19 |