| NPI | 1942280813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61792) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 24507) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-12-27 |