| NPI | 1205082534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 10066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4171) |
| 225100000X Physical Therapist (Licence: HI 2949) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2009-03-12 |