| NPI | 1417083064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 346435-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010324) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |