| NPI | 1356712715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024740) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2019-05-16 |