| NPI | 1942743398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 294257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29918) |
| 225100000X Physical Therapist (Licence: VA 2305210590) | |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2024-05-16 |