| NPI | 1215137476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32375) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2012-05-03 |