| NPI | 1639227093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00002563) |
| 225100000X Physical Therapist (Licence: CA 8597) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |