| NPI | 1841336203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 0878) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 7816) |
| 225100000X Physical Therapist (Licence: HI 0842) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-05-18 |