| NPI | 1730164690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 0334) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009718) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2012-11-13 |