| NPI | 1245403674 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010511) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4968) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2022-11-08 |