| NPI | 1124207428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 38297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002132) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2015-07-09 |