| NPI | 1750372116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT22738) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1203) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-11-16 |