| NPI | 1831534502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 39822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24451) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2017-11-17 |