| NPI | 1831264381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 6900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32955) |
| 225100000X Physical Therapist (Licence: NC 9780) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-06-24 |