| NPI | 1710369145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 23859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28378) |
| 225100000X Physical Therapist (Licence: PA 009608L) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-10-20 |