| NPI | 1336503713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291327) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2018-03-17 |