| NPI | 1639459480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 38002) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OH 013400) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2019-04-03 |