| NPI | 1104296581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR 62235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 43134) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-03-27 |