NPI | 1639155237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010802) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4927) |
Enumeration Date | 2005-12-16 |
Last Update Date | 2010-11-03 |