| NPI | 1689191231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT293302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 193302) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-08-19 |