| NPI | 1689092397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35991) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 35991) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-12-13 |