| NPI | 1841560042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 38506) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 049902396) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |