| NPI | 1912436676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60757662) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-01-25 |