| NPI | 1811014731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT14466) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.015363) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2023-01-26 |