| NPI | 1376299776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT301770) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 301770) |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2022-11-21 |