| NPI | 1093297830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT308596) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2026-01-08 |