| NPI | 1801934559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33462) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-10-29 |