| NPI | 1609403245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296250) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10126) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-04-08 |