| NPI | 1083922645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60189872) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2010030201) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2012-11-12 |