| NPI | 1205105202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60257881) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2023-10-10 |