| NPI | 1265072904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: CA 03316548) |
| Additional Taxonomies | 261QX0100X Clinic/Center Occupational Medicine (Licence: CA 03316548) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-01-14 |