| NPI | 1710258561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35244) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 35244) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-01-24 |