| NPI | 1205896354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 7543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3089) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2009-10-15 |