| NPI | 1255740866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60474879) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60474879) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-12-15 |