| NPI | 1164890174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 43059) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2025-03-12 |