| NPI | 1205064904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022697) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2016-12-29 |