| NPI | 1144280587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 3604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT 3231) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2008-09-15 |