| NPI | 1265521983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010246) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-11-08 |