| NPI | 1366446601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT28263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 28263) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2025-03-06 |