| NPI | 1174613202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 1518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32803) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |