| NPI | 1114291838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4423) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38698) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2023-07-18 |