| NPI | 1356171904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30360) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306246) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |