| NPI | 1538778915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 309009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1331853) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2026-03-02 |