| NPI | 1922793819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 306650) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist Orthopedic (Licence: FL PT33935) | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-10-04 |