| NPI | 1265087217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CA 297019) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 297019) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-03-23 |