| NPI | 1437134244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009335) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009600) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2009-05-18 |