| NPI | 1043385958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028757) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2011-01-28 |