| NPI | 1679167183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Y00000X Clinical Exercise Physiologist (Licence: CA 1070508) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 77199) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2025-05-27 |