| NPI | 1649305145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 30447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17691) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-12-03 |