| NPI | 1285664094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 00006115) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: WA 00006115) |
| 2251N0400X Physical Therapist, Neurology (Licence: WA 00006115) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-10-06 |