| NPI | 1144852963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT298088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 298088) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2025-01-06 |