| NPI | 1295972255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4847) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 19511) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2009-04-14 |