| NPI | 1912347535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292996) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11016PT) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-05-08 |