| NPI | 1467437962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00006768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 2352) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2014-07-01 |