| NPI | 1720636400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298002) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 27660) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2023-02-23 |