| NPI | 1962551085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT30445) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 012236) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-09-21 |