| NPI | 1831408277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60379) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60184409) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2016-07-22 |