| NPI | 1225540594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014976) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2018-11-27 |