| NPI | 1366990756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 292010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292010) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2023-04-27 |