| NPI | 1821872243 |
|---|---|
| Other Name | N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 304680) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA 304680) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |