| NPI | 1306250840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60610723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41383) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2016-01-21 |