| NPI | 1649693847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 05661) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2014-01-24 |