| NPI | 1275219891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 304141) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 13119) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-06-27 |