| NPI | 1629573712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16926) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2026-01-26 |