| NPI | 1881066819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT297910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11898) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2020-01-10 |