| NPI | 1801057765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60074448) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5697) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2009-06-24 |