| NPI | 1124324611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60194846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60019) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2016-11-23 |