| NPI | 1265702807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 012196) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |