| NPI | 1215076682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 66741782401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008334) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: WA PT00008334) | |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2013-12-31 |