| NPI | 1346807567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT299978) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-12-13 |