| NPI | 1336334374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10762) |
| 225100000X Physical Therapist (Licence: MN 8265) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2012-12-03 |