NPI | 1295356913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT304000) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA PTA49201) |
Enumeration Date | 2020-05-05 |
Last Update Date | 2023-05-30 |