| NPI | 1174858690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60124066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2577) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2011-03-04 |