| NPI | 1336369289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010031) |
| 225100000X Physical Therapist (Licence: MI 5501012014) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |