| NPI | 1093784134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT27832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870711) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2019-01-10 |