| NPI | 1699065755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: WA 60198453) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OR 6398) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: CA 26149) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |