| NPI | 1275762338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36174) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 5995) |
| 225100000X Physical Therapist (Licence: WA PT60323144) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2021-08-09 |