| NPI | 1043740749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294806) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA 294806) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-03-10 |