| NPI | 1881032241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 40111) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2017-05-03 |