| NPI | 1174554075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT23494) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2026-03-09 |