| NPI | 1144764820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 233988) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292488) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2026-03-10 |