| NPI | 1235745514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298683) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CPO14329T) |
| 225100000X Physical Therapist (Licence: MD 28405) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2024-09-30 |