| NPI | 1457356404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00006628) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034484) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-03-06 |