| NPI | 1447444005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60162661) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10977) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2013-09-03 |