| NPI | 1932121167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1711) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008839) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-06-29 |