| NPI | 1275869273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36115) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2012-04-06 |