| NPI | 1962771063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT39259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13213) |
| 225100000X Physical Therapist (Licence: DE J1-0002670) | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2013-10-03 |