| NPI | 1104187384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60414850) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06515) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2013-10-21 |