| NPI | 1063892602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038455-1) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2017-03-20 |