| NPI | 1356119762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 306506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050230) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2024-08-27 |