| NPI | 1932427937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT34283) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2016-08-22 |