| NPI | 1386663698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC PT11595) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT16003) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-07-24 |