| NPI | 1427712736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047801) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2023-07-19 |