| NPI | 1609481621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61271746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63818) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2022-04-27 |