| NPI | 1649250796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00006055) |
| 225100000X Physical Therapist (Licence: WI 3793) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2012-11-02 |