| NPI | 1346257805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 19318) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41255) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-03-04 |