| NPI | 1013903442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT7859) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2020-12-03 |