| NPI | 1487621710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 26884) |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2007-07-08 |