| NPI | 1437543402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292729) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 9527) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2019-12-31 |