| NPI | 1689215956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045020) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2023-08-04 |