| NPI | 1275998932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT291509) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209986) |
| 225100000X Physical Therapist (Licence: IL 070022267) | |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2025-07-10 |