| NPI | 1245471655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60056316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5808) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |