| NPI | 1811347339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014080) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2022-02-11 |