| NPI | 1831918465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 3043172-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 308213) |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2025-10-20 |