| NPI | 1912782285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 212767) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 304739) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2024-07-21 |