| NPI | 1336356708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1171678) |
| 225100000X Physical Therapist (Licence: MI 5501011573) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |