| NPI | 1205167897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 35469) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2011-11-15 |