| NPI | 1881068260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT296744) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039720) |
| Enumeration Date | 2015-11-22 |
| Last Update Date | 2022-08-05 |