| NPI | 1578195954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297885) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019973) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2025-07-14 |