| NPI | 1821675844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT299947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-7619) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2021-10-13 |