| NPI | 1376976761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1234577) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2016-08-18 |