| NPI | 1093312134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PT298982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT298982) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2024-01-12 |