| NPI | 1033001672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 308040) |
| Enumeration Date | 2025-07-17 |
| Last Update Date | 2025-12-29 |