| NPI | 1699273078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13261) |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2018-01-31 |