| NPI | 1588353007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT303292) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-05-02 |