| NPI | 1023593902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT304810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043117) |
| 225100000X Physical Therapist (Licence: CO PTL.0018134) | |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2024-02-09 |