| NPI | 1821335910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 38877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62209) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2019-01-09 |