| NPI | 1851830392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT293241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22806) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2020-07-13 |