| NPI | 1043388358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 11937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 3142) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2017-09-08 |