| NPI | 1164643466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ az4402) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-09-28 |