| NPI | 1306420476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT309855) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA PTA49767) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2026-03-17 |