| NPI | 1124138508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00007033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 7033) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-03-06 |