| NPI | 1023034899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32340) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-06-05 |