| NPI | 1578501052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT32430) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2025-11-21 |