| NPI | 1447850672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61116067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63823) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |