| NPI | 1215683347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 310146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018227) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2026-05-28 |