| NPI | 1518397744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20837) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2013-11-25 |