| NPI | 1881709046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00005465) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |