| NPI | 1184603821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR 4082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 00008327) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2008-11-19 |