| NPI | 1225285901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD T-6338) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2021-10-11 |