| NPI | 1578749891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT29163) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009003) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2016-09-14 |