| NPI | 1912956244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 8782) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 5485) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-09 |