| NPI | 1356447197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: OR 63922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009419) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2024-05-03 |