| NPI | 1013575984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4787) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2021-04-06 |