| NPI | 1063454361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT27899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL-9558) |
| 225100000X Physical Therapist (Licence: FL PT20143) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-01-17 |