| NPI | 1770696684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12262) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 27684) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-10-25 |