| NPI | 1104531672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020907) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61675054) |
| 225100000X Physical Therapist (Licence: CA 305820) | |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2025-10-16 |