| NPI | 1639273162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 00003826) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT3826) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2015-07-02 |