| NPI | 1295574267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26576) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2025-08-29 |