| NPI | 1689775553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT 009043) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |