| NPI | 1942275938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 11518) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2012-10-29 |