| NPI | 1982155289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299595) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT10385) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2023-10-27 |