| NPI | 1265169494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306270) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2026-01-08 |