| NPI | 1164711156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2641) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 10234) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-03-31 |