| NPI | 1528074457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41519) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5146) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-09-03 |