| NPI | 1629656574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303378) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC34994) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2023-12-11 |