| NPI | 1164472585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT21849) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2026-04-14 |