| NPI | 1063873651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034084) |
| 225100000X Physical Therapist (Licence: WA PT60408466) | |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2018-12-31 |