| NPI | 1174504369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00003591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 1596) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2022-02-15 |