| NPI | 1174669832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 0003843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 003321) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-01-12 |