| NPI | 1790876449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT293314) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-07-21 |