| NPI | 1770780678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007644) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-08 |