| NPI | 1922073881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 8711) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2013-08-16 |