| NPI | 1457214751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308794) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018500) |
| Enumeration Date | 2025-12-04 |
| Last Update Date | 2026-08-12 |