| NPI | 1457072118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 302429) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2026-01-27 |