| NPI | 1902998065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT27916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009751) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-12-10 |