| NPI | 1922175330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305203630) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-03-23 |