| NPI | 1336567023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 41176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037122) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2014-03-31 |