| NPI | 1932206281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 23204) |
| 225100000X Physical Therapist (Licence: CO 8644) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-11-22 |