| NPI | 1871911958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292198) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-07-27 |