| NPI | 1851804553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294088) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2020-12-10 |