| NPI | 1922408285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294150) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26584) |
| Enumeration Date | 2014-08-23 |
| Last Update Date | 2018-04-18 |