| NPI | 1831547736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291676) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-11-04 |