| NPI | 1316617442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT305226) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37649) |
| 225100000X Physical Therapist (Licence: VA 2305215512) | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2023-11-20 |