| NPI | 1538396874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60058512) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2009-06-16 |