| NPI | 1134520752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023724) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2019-04-12 |