| NPI | 1831379536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9314) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT24712) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2011-09-26 |