| NPI | 1356622914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4481) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT38123) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2015-08-04 |