| NPI | 1962834291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3162) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2018-03-17 |