| NPI | 1871931352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1223985) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2021-11-22 |