| NPI | 1316495856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT010858L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 43200) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2026-06-26 |