| NPI | 1952388399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 15705) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2007-11-05 |