| NPI | 1346958113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61529887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64744) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2024-07-01 |