| NPI | 1073742334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60170042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR T 6021) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2015-03-25 |