| NPI | 1043336134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010308) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 7902) |
| 225100000X Physical Therapist (Licence: CT 7567) | |
| 225100000X Physical Therapist (Licence: OR 5395) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-03-21 |