| NPI | 1285666438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64227) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA PT00002041) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-08-10 |