| NPI | 1699288159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294416) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2021-12-01 |