| NPI | 1760144398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31974) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2023-07-06 |