| NPI | 1225133663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT396) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2008-02-11 |