| NPI | 1326162439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010397) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA PT00010397) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2017-03-15 |