| NPI | 1861460719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2754) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: CA 1021100611) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |