| NPI | 1396216537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 296064) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2022-12-08 |