| NPI | 1730691627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT294289) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 3614) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2026-03-27 |