| NPI | 1891935516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 6292258-2401) |
| Enumeration Date | 2009-02-21 |
| Last Update Date | 2009-04-28 |