| NPI | 1043313497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 1411) |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care (Licence: PR 1333) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2011-04-08 |