| NPI | 1417690413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT305000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 111933) |
| 225100000X Physical Therapist (Licence: IL 070.026471) | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2024-12-19 |