| NPI | 1902370471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297827) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043809) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2023-11-06 |