| NPI | 1518763747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 307594) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 307594) |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-25 |