| NPI | 1831578574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1137859) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |