| NPI | 1568446433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 1889) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2012-10-29 |