| NPI | 1629136916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT4098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT11617) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2016-06-06 |