| NPI | 1790889806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 10596) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT10596A) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2026-07-17 |