| NPI | 1437934205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306829) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 12028) | |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2024-10-01 |