| NPI | 1841360252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60313589) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 028187) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2013-05-21 |