| NPI | 1821465535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60772918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61356) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2017-12-01 |