| NPI | 1407300486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16185) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291810) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2025-05-13 |