| NPI | 1356657134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ PT9578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT37054) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2012-07-23 |