NPI | 1407255649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63047) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA PT60478651) |
Enumeration Date | 2014-08-13 |
Last Update Date | 2018-12-06 |