| NPI | 1053401463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3249) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007463) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2007-07-08 |