| NPI | 1891337671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297455) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11258) |
| Enumeration Date | 2019-10-12 |
| Last Update Date | 2019-10-25 |