| NPI | 1497386395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306813) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2025-10-13 |