| NPI | 1013654029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3128537) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2023-11-22 |