| NPI | 1396501128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 309466) |
| 225100000X Physical Therapist (Licence: NC CP048707T) | |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2025-12-17 |