| NPI | 1184910770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60478607) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61342438) |
| 225100000X Physical Therapist (Licence: OR 60568) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2025-01-10 |