| NPI | 1063575090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40092) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 0250941) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2013-09-19 |