| NPI | 1669823514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT42494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT24004) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2016-06-22 |