| NPI | 1104366913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI PT5085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT291900) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2022-01-19 |