| NPI | 1417991068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00002972) |
| 225100000X Physical Therapist (Licence: CA PT7504) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2011-10-25 |