| NPI | 1942935531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 304257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26194) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2024-02-07 |