| NPI | 1295353787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT298450) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2025-07-31 |