| NPI | 1871632646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT2909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT28099) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-10-16 |