| NPI | 1508074816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA PT32333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT PT32333) |
| 225100000X Physical Therapist (Licence: CA PT32333) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-01-25 |