| NPI | 1295849636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00006487) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2017-04-26 |