| NPI | 1528276961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 25383) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2016-09-19 |