| NPI | 1720539356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60670985) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2022-02-01 |