| NPI | 1508809591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT352) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00003201) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2010-06-29 |