| NPI | 1790526424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 306179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16792-24) |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-08-28 |