| NPI | 1609844513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00002582) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-05-05 |