| NPI | 1114275344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 5006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 39293) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2023-05-01 |