| NPI | 1598205452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292377) |
| 2251S0007X Physical Therapist, Sports (Licence: CA PT292377) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT292377) | |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2023-04-11 |