| NPI | 1942866033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63154) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2020-12-04 |