| NPI | 1285107748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60788424) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62425) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-10-25 |