| NPI | 1700260544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61167387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61069) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2022-01-18 |