| NPI | 1831320845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60096812) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2013-09-24 |