| NPI | 1437131398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3544) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007475) |
| 225100000X Physical Therapist (Licence: TX 1108710) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-08 |