| NPI | 1043375058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 30003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1352) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2018-03-17 |