| NPI | 1477127975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT300197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300197) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-08-05 |