| NPI | 1710783634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT307638) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 307694) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-06-02 |