| NPI | 1902092562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 1445) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT30149) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2013-12-18 |