| NPI | 1811257900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38972) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2020-11-17 |