| NPI | 1710299342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT39789) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010684A) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2022-07-15 |