| NPI | 1720066780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2675) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4199) |
| 225100000X Physical Therapist (Licence: WA PT00005973) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2012-06-18 |