| NPI | 1750063350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 304886) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2025-04-16 |