| NPI | 1962418905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT959) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-02-07 |