| NPI | 1255174868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307493) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020963) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2025-12-03 |