| NPI | 1932566254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 4632) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 10492) |
| Enumeration Date | 2016-01-16 |
| Last Update Date | 2018-09-18 |