| NPI | 1003497116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65111) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: CA 302169) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-05-08 |