| NPI | 1912087198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17659) |
| 225100000X Physical Therapist (Licence: WA PT00010844) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2012-11-28 |