| NPI | 1861121667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT304230) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38852) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2023-09-27 |