| NPI | 1942758255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62885) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT291960) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2025-09-18 |