| NPI | 1861047102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299193) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027859) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2020-11-05 |