| NPI | 1518504000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT306180) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60991357) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2025-11-19 |