| NPI | 1548431364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34855) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028059) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2011-04-11 |