| NPI | 1629402052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60401257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60311) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2014-02-13 |