| NPI | 1396729240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008488) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 10831) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2015-11-13 |