| NPI | 1730819624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299325) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 030026) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-10-01 |