| NPI | 1689651002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2583) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PT 29450) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2009-03-31 |