| NPI | 1700102589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35671) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2003029517) |
| 225100000X Physical Therapist (Licence: IL 070015600) | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2010-04-19 |