| NPI | 1386767341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 6170) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT25594) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-05-19 |