| NPI | 1710191341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 9624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 2064) |
| 225100000X Physical Therapist (Licence: NY 7527) | |
| 225100000X Physical Therapist (Licence: NE 1100) | |
| 2251C2600X Physical Therapist, Cardiopulmonary (Licence: NE 1100) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |