| NPI | 1033219126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65508) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007581) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-10-24 |