| NPI | 1578700167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 27620) |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2009-01-19 |