| NPI | 1861787871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8722) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2014-10-27 |