| NPI | 1699443531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28580) |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2025-01-10 |