| NPI | 1487016044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41782) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9945) |
| 225100000X Physical Therapist (Licence: TX 1269463) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2016-03-23 |