| NPI | 1306987284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT34210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17821) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-12-07 |