| NPI | 1093936411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 21218) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2013-07-18 |