| NPI | 1023644424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60473560) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-03-17 |