| NPI | 1477922391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 28500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1256606) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2022-02-11 |