| NPI | 1194369645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61012542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62896) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2019-10-29 |