| NPI | 1952509986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT6855) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT1425) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2007-07-11 |