| NPI | 1710082011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 024711) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2008-04-15 |