| NPI | 1851866644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043399-1) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2022-09-27 |