| NPI | 1194707224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4623) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2011-02-21 |