| NPI | 1881973055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 38028) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60234339) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2013-11-14 |