| NPI | 1235797119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT301532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027627) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2024-10-18 |