| NPI | 1255099784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28765) |
| 225100000X Physical Therapist (Licence: CA 303594) | |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2025-08-05 |