| NPI | 1760072961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP041093T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 299710) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2025-04-17 |