| NPI | 1962698225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2884) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33374) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2017-04-28 |