| NPI | 1205877628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295875) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 005284) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2025-12-12 |