| NPI | 1649280132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR 6654) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 29521) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-11-13 |