| NPI | 1073231403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303096) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 049330) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-11-17 |