| NPI | 1902964943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 4674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT17531) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2013-10-22 |