| NPI | 1205868577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA PHYSICAL THERAPY) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 27313) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |