| NPI | 1629558499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294903) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-08-14 |