| NPI | 1083553259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 25169) |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-04-08 |