| NPI | 1992755417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL8371) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-12-12 |