| NPI | 1265103410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT307446) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37364) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2025-02-28 |