| NPI | 1710698899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 303262) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT303262) |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2023-11-08 |