| NPI | 1871619908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2526) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33225) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |