| NPI | 1952823767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293758) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62236) |
| 225100000X Physical Therapist (Licence: NM 4469) | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |