| NPI | 1184190159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 43469) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23646) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |