| NPI | 1871707620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60111917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1145852) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2010-03-08 |