| NPI | 1841555265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60615361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06902) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2015-12-16 |