| NPI | 1851608426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT36980) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2025-01-21 |