| NPI | 1861508269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 4131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3312) |
| 225100000X Physical Therapist (Licence: CA 25431) | |
| 225100000X Physical Therapist (Licence: OR 3786) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |