| NPI | 1174862593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60972498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 04285) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2024-09-24 |