| NPI | 1629720917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP042519T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT305251) |
| 225100000X Physical Therapist (Licence: NJ 40QA02075300) | |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2025-03-10 |