| NPI | 1528578119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT293772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-19458) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2023-03-23 |