| NPI | 1801004163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12941) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT29084) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-10-15 |