| NPI | 1306052915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204506) |
| 225100000X Physical Therapist (Licence: ME PT2925) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2011-08-15 |