| NPI | 1518432855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295271) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT295271) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2024-05-15 |