| NPI | 1295075430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09870R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39895) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2020-07-01 |