| NPI | 1982100269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT294362) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2019-09-23 |