| NPI | 1568153187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 40269) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2025-09-06 |