| NPI | 1558995829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 302248) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2022-08-04 |