| NPI | 1255989174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT296824) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23079) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2019-09-04 |