| NPI | 1053377721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007408) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2011-08-05 |