| NPI | 1194338962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT300286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25127) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2025-08-06 |