| NPI | 1053830513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60788710) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2022-11-14 |