| NPI | 1689818320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010664) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5546) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2014-12-25 |