| NPI | 1669905931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT291522) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT291522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-04-14 |