| NPI | 1558794792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28452) |
| 225100000X Physical Therapist (Licence: AZ 12026) | |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2018-05-15 |