| NPI | 1861007478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT299092) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 299092) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2021-11-04 |