| NPI | 1922131606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 0PT276730) |
| 225100000X Physical Therapist (Licence: OR 5493) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2012-07-02 |