| NPI | 1174696561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 5233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 25230) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |