| NPI | 1871921080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034791-1) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2016-06-23 |