| NPI | 1255459699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3813) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-11-02 |