| NPI | 1386795862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010818) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 1525) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2024-11-24 |