| NPI | 1396943189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2044) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WA PT0009329) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |