| NPI | 1386269744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT298826) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2023-01-31 |