NPI | 1942448923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT19096) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 19096) |
Enumeration Date | 2009-01-28 |
Last Update Date | 2018-05-10 |