| NPI | 1962602706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: WA PT00009695) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: OR 3892) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-11-16 |