| NPI | 1679557003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00006307) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3221) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2017-07-18 |