| NPI | 1942801568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 298833) |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |