| NPI | 1316186802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018591) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2009-02-06 |