| NPI | 1396877130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 9182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4727) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2021-12-29 |