| NPI | 1922751734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT303961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048018-01) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-02-13 |