| NPI | 1548740525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295194) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT295194) |
| Enumeration Date | 2018-08-18 |
| Last Update Date | 2023-11-27 |