| NPI | 1871692632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6304) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT28977) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-08-19 |