| NPI | 1578686853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33991) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62-028771) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-01-31 |