| NPI | 1003898958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007583) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-10 |