| NPI | 1932743515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297641) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2022-03-10 |