| NPI | 1861440406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00003833) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00003713) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2018-10-02 |