| NPI | 1548213689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2919) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008894) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-04-01 |