| NPI | 1851603138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT37283) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2016-12-02 |