| NPI | 1619990546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007703) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-01-02 |