| NPI | 1477829638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 39804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032666) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2016-01-06 |