| NPI | 1801050703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008791 A) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-09-24 |