| NPI | 1285271510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9960) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP042384T) |
| 225100000X Physical Therapist (Licence: OR CP025250T) | |
| 225100000X Physical Therapist (Licence: CA 301394) | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2025-02-18 |