| NPI | 1093400707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044165) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-02-01 |