| NPI | 1538627401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26033) |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2021-07-07 |