| NPI | 1760924724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64435) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2025-11-05 |