| NPI | 1568884179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 40736) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2024-05-22 |