| NPI | 1184734311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4416) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-02-19 |