| NPI | 1184600298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 24730) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2007-07-08 |