| NPI | 1508186669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60628838) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR PT06294) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2016-03-25 |