| NPI | 1831737212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP000903T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9726) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2019-12-16 |