| NPI | 1023180627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 9160) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |