| NPI | 1851911820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292576) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251N0400X Physical Therapist, Neurology | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2020-04-20 |