| NPI | 1578612511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 29757) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 18958) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |