| NPI | 1205171535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207719) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2023-12-05 |