| NPI | 1710213475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 23112) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2015-09-18 |