| NPI | 1336366558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204961) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2011-05-04 |