| NPI | 1306645528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 33090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 303325) |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-03-10 |