| NPI | 1053768465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60465913) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2024-01-12 |