| NPI | 1922276641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005424) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA RN00078213) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |