| NPI | 1902860844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4747) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 9311) |
| 225100000X Physical Therapist (Licence: CA PT25621) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2012-07-24 |