| NPI | 1124254156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1175029) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60086522) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2012-03-15 |