| NPI | 1356496673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005013904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT33905) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-10-18 |