| NPI | 1487399143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303505) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37825) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2023-07-07 |