| NPI | 1912237330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT38896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT25247) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2019-12-02 |