| NPI | 1972997849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42346) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2021-10-20 |