| NPI | 1477439313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 309326) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 49439) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2025-12-29 |