| NPI | 1982096921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT42308) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60641768) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2021-12-29 |