| NPI | 1154466043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005321) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC00002074) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-04-13 |