| NPI | 1548275266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60264363) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027991-1) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2013-04-10 |