| NPI | 1083728521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007435) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-01-05 |