| NPI | 1275861866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 13085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT36208) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WY 1408) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT36208) | |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2023-01-05 |