| NPI | 1790874485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15281-24) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CA PT15047) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2025-07-18 |