| NPI | 1467699553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37754) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 24529) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2022-02-11 |