| NPI | 1801223466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7023) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37665) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2023-08-02 |