| NPI | 1538739214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 50984) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 50984) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |