| NPI | 1154163186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT306848) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA Pending) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-03-03 |