| NPI | 1972110179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296741) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2026-05-27 |