| NPI | 1982659686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 9023) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5176) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-10-31 |