| NPI | 1508346941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60855203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62946) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |