| NPI | 1821156167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 05883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT33173) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-04-11 |