| NPI | 1235512336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11415) |
| 225200000X Physical Therapy Assistant (Licence: CA 9408) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |