| NPI | 1063429835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 10864) |
| 225100000X Physical Therapist (Licence: OR 5587) | |
| 225100000X Physical Therapist (Licence: AZ 8271PT) | |
| 225100000X Physical Therapist (Licence: TX 1241938) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-07-17 |