| NPI | 1174292759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 310388) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 37756) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2026-07-08 |