| NPI | 1275972549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38852) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2016-05-26 |