| NPI | 1629016142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60146430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 1461) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2014-05-28 |