| NPI | 1073595542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 0365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 6477) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2007-11-08 |