| NPI | 1750320677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008736) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2010-06-29 |