| NPI | 1205601481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT305770) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2024-03-14 |