| NPI | 1447730775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043447) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2021-05-25 |