| NPI | 1538631049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1302440) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60839855) |
| 225100000X Physical Therapist (Licence: OR 62636) | |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2020-07-19 |