| NPI | 1891925160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5934) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2007021001) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-22 |