| NPI | 1063679074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14455) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 32267) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2019-05-23 |