| NPI | 1518900174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5797) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009936) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-03-23 |