| NPI | 1265969745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 29176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291761) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2024-03-20 |