| NPI | 1033415567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60980499) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6673) |
| 225100000X Physical Therapist (Licence: TX 1146241) | |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2024-07-03 |