| NPI | 1285760033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 4877705-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010369) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2015-07-15 |