| NPI | 1689691644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT30018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2659) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-07-22 |