| NPI | 1467774109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PT00009267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29090) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2024-05-03 |