| NPI | 1902902570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT9033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-1797) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-09-30 |