| NPI | 1437330933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT33585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 9180) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2012-10-29 |