| NPI | 1740467455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60160912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 05581) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2010-11-03 |