| NPI | 1710404983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26052) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-09-21 |