| NPI | 1134003171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 306715) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306899) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |