| NPI | 1952849184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2017003392) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-12-27 |