| NPI | 1942497540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34064) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21662) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2019-03-22 |