| NPI | 1558512046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5489) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2021-06-07 |