| NPI | 1871372789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 309768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL28021) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2026-04-06 |