| NPI | 1992993406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT21736) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |