| NPI | 1043287246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20871) |
| 225100000X Physical Therapist (Licence: DC PT870023) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-08 |