| NPI | 1508289885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 3637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39213) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2022-11-02 |