| NPI | 1093398315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 302724) |
| 225100000X Physical Therapist (Licence: PA PT029634) | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-06-04 |