| NPI | 1689881054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 1147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009588) |
| 225100000X Physical Therapist (Licence: AZ 6738) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2008-10-29 |