| NPI | 1447234943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00004086) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 01630) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2011-05-04 |