| NPI | 1114654829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1329142) |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2023-12-07 |