| NPI | 1548252174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36838) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1834) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2015-07-01 |