| NPI | 1639208762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 29207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 2677) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-06-26 |