| NPI | 1457923294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61203784) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2023-06-08 |