| NPI | 1124003223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: WA PT00007743) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: OR 3039) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2009-10-23 |