| NPI | 1427381516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009993) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 05169) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2025-08-06 |