| NPI | 1932391398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3804) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2014-04-14 |