| NPI | 1689129520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT298540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212381) |
| 225100000X Physical Therapist (Licence: AL PTH9238) | |
| 225100000X Physical Therapist (Licence: NJ 40QA01584000) | |
| Enumeration Date | 2016-08-21 |
| Last Update Date | 2020-10-07 |