| NPI | 1063084093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CA PT300341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT300341) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2026-01-20 |