| NPI | 1144271388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT 2388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 28993) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-11-07 |