| NPI | 1306829254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00003235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-26 72) |
| 225100000X Physical Therapist (Licence: OR 1018) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2016-10-11 |