| NPI | 1992813059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60563979) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-07-29 |