| NPI | 1659512119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT-20879) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2020-01-31 |