| NPI | 1275104036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 306162) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTL.0017741) |
| 225100000X Physical Therapist (Licence: VA 2305214651) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2024-08-28 |