| NPI | 1518119783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT294673) |
| Enumeration Date | 2008-10-18 |
| Last Update Date | 2019-05-14 |