| NPI | 1043253032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00002841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 6513) |
| 225100000X Physical Therapist (Licence: OR 2481) | |
| 225100000X Physical Therapist (Licence: AZ 2534) | |
| 225100000X Physical Therapist (Licence: NV 1788) | |
| 225100000X Physical Therapist (Licence: ID PT 749) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |