| NPI | 1295123321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294159) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 9025) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2020-01-30 |