| NPI | 1629646633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33232) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-06-15 |