| NPI | 1972858348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296360) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24122) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2019-06-10 |