| NPI | 1093346926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297764) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2024-04-23 |