| NPI | 1053796425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 40930) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |