| NPI | 1104808955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4573) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2220) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2007-07-08 |