| NPI | 1205986817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 4852) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 6736) |
| 225100000X Physical Therapist (Licence: OR 3561) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2024-09-17 |