| NPI | 1881662765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1538) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-06-07 |