| NPI | 1558495077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027120) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-01-18 |