| NPI | 1922719657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP022848T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 302347) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2023-07-25 |