| NPI | 1811704125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT307190) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA PT307190) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT307190) | |
| Enumeration Date | 2024-12-11 |
| Last Update Date | 2024-12-11 |