| NPI | 1487519245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 310512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA P23808) |
| Enumeration Date | 2025-12-23 |
| Last Update Date | 2026-08-05 |