| NPI | 1619107893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2230PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36060) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2014-10-23 |