| 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 |