| NPI | 1679817233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-2888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT-34372) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |