| NPI | 1912674755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4376) |
| Enumeration Date | 2021-08-28 |
| Last Update Date | 2022-02-03 |