| NPI | 1578708343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60428438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004189) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2014-03-21 |