| NPI | 1598973745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305203973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 28738) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2008-07-28 |